Ductal Carcinoma In Situ Close to the Inked Margin: A Case Presented in Multidisciplinary Session With Clinical Discussion and Decision Making

Ahmad Elahi (1), Gholamreza Toogeh (2), Habibollah Mahmoodzadeh (3), Behnaz Jahanbin (4), Farhad Shahi (5), Bita Kalaghchi (6), Nahid Sedighi (7)
(1) Division of Breast Surgical Oncology, Department of Surgery, Alborz University of Medical Sciences, Karaj, Iran, Iran, Islamic Republic of,
(2) Hematology and Medical Oncology Department, Thrombosis Hemostasis Research Center, Tehran University of Medical Sciences, Tehran, Iran, Iran, Islamic Republic of,
(3) Division of Surgical Oncology, Department of Surgery, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran, Iran, Islamic Republic of,
(4) Cancer Research Center, Department of Pathology, Tehran University of Medical Sciences, Tehran, Iran, Iran, Islamic Republic of,
(5) Hematology and Medical Oncology Department, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran, Iran, Islamic Republic of,
(6) Radiation Oncology Research center, Department of Radiation Oncology, Tehran University of Medical Sciences, Tehran, Iran, Iran, Islamic Republic of,
(7) Medical Imaging Center, ADIR, Cancer Institute, Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran, Iran, Islamic Republic of

Abstract

Background: For many years, the acceptable margins of the resections for ductal carcinoma in situ (DCIS) has been 2 mm, although, in some reports and the recent updates of some guidelines, the closer margins are also declared as acceptable in some circumstances. Despite these new recommendations, the safe margin in DCIS remains a matter of controversy in many institutional and national guidelines.
Case Presentation: A woman with invasive breast cancer with associated DCIS presented to our clinic. She underwent breast-conserving surgery, and pathology report showed one focus of DCIS at a distance of <?1 mm from inked margin. This case was presented in the weekly breast multidisciplinary team session of the Department of Breast Surgery, Tehran University of Medical Sciences.
Question: The question was whether the patient should be operated again to obtain more extensive margins for DCIS or the radiation therapy would be enough as the next step in her treatment.
Conclusion: According to the latest published guidelines, the members of panel decided to accept the margin and informed the patient about the risk of recurrence and the need for adjuvant radiotherapy and follow-up modalities.

Full text article

Generated from XML file

References

Burstein HJ, Polyak K, Wong JS, Lester SC, Kaelin CM. Ductal carcinoma in situ of the breast. N Engl J Med. 2004;350(14):1430-41.

Dodwell D, Clements K, Lawrence G, Kearins O, Thomson CS, Dewar J, et al. Radiotherapy following breast-conserving surgery for screen-detected ductal carcinoma in situ: indications and utilisation in the UK. Interim findings from the Sloane Project. Br J Cancer. 2007;97(6):725-9.

McCormick B, Winter K, Hudis C, Kuerer HM, Rakovitch E, Smith BL, et al. RTOG 9804: a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation. J Clin Oncol. 2015;33(7):709-15.

Morrow M, Van Zee KJ, Solin LJ, Houssami N, Chavez-MacGregor M, Harris JR, et al. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Ductal Carcinoma in Situ. Pract Radiat Oncol. 2016;6(5):287-95.

Schulman AM, Mirrielees JA, Leverson G, Landercasper J, Greenberg C, Wilke LG. Reexcision Surgery for Breast Cancer: An Analysis of the American Society of Breast Surgeons (ASBrS) Mastery(SM) Database Following the SSO-ASTRO "No Ink on Tumor" Guidelines. Ann Surg Oncol. 2017;24(1):52-8.

Tang SS, Kaptanis S, Haddow JB, Mondani G, Elsberger B, Tasoulis MK, et al. Current margin practice and effect on re-excision rates following the publication of the SSO-ASTRO consensus and ABS consensus guidelines: a national prospective study of 2858 women undergoing breast-conserving therapy in the UK and Ireland. Eur J Cancer. 2017;84:315-24.

Marinovich ML, Azizi L, Macaskill P, Irwig L, Morrow M, Solin LJ, et al. The Association of Surgical Margins and Local Recurrence in Women with Ductal Carcinoma In Situ Treated with Breast-Conserving Therapy: A Meta-Analysis. Ann Surg Oncol. 2016;23(12):3811-21.

Heelan Gladden AA, Sams S, Gleisner A, Finlayson C, Kounalakis N, Hosokawa P, et al. Re-excision rates after breast conserving surgery following the 2014 SSO-ASTRO guidelines. Am J Surg. 2017;214(6):1104-9.

Kuerer HM, Smith BD, Chavez-MacGregor M, Albarracin C, Barcenas CH, Santiago L, et al. DCIS Margins and Breast Conservation: MD Anderson Cancer Center Multidisciplinary Practice Guidelines and Outcomes. J Cancer. 2017;8(14):2653-62.

Association of Breast Surgery (ABS) Consensus Margin Width in Breast Conservation Surgery 2015. 2017 [Available from: www.associationofbreastsurgery.org.uk

NCCN clinical practice guidelines in oncology (NCCN guidelines): breast cancer. 2017 [Available from: http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf.

Ekatah GE, Turnbull AK, Arthur LM, Thomas J, Dodds C, Dixon JM. Margin width and local recurrence after breast conserving surgery for ductal carcinoma in situ. Eur J Surg Oncol. 2017;43(11):2029-35.

Morrow M. De-escalating and escalating surgery in the management of early breast cancer. Breast. 2017;34 Suppl 1:S1-S4.

Pilewskie M, Morrow M. Margins in breast cancer: How much is enough? Cancer. 2018.

Van Zee KJ, Subhedar P, Olcese C, Patil S, Morrow M. Relationship between margin width and recurrence of ductal carcinoma in situ: analysis of 2996 women treated with breast-conserving surgery for 30 years. Annals of surgery. 2015;262(4):623.

Authors

Ahmad Elahi
elahi84@gmail.com (Primary Contact)
Gholamreza Toogeh
Habibollah Mahmoodzadeh
Behnaz Jahanbin
Farhad Shahi
Bita Kalaghchi
Nahid Sedighi
Author Biographies

Ahmad Elahi, Division of Breast Surgical Oncology, Department of Surgery, Alborz University of Medical Sciences, Karaj, Iran

Ahmad Elahi, MD
Address: Imam Ali Hospital Complex, Chamran Blvd,
Azimieh, Karaj, Iran
Tel: +98 26 32527575
Fax: +98 26 32547128
Email: elahi84@gmail.com

Habibollah Mahmoodzadeh, Division of Surgical Oncology, Department of Surgery, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran

 

 

Farhad Shahi, Hematology and Medical Oncology Department, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran

 

 

1.
Elahi A, Toogeh G, Mahmoodzadeh H, Jahanbin B, Shahi F, Kalaghchi B, Sedighi N. Ductal Carcinoma In Situ Close to the Inked Margin: A Case Presented in Multidisciplinary Session With Clinical Discussion and Decision Making. Arch Breast Cancer [Internet]. 2018 Jun. 8 [cited 2024 May 23];:58-62. Available from: https://archbreastcancer.com/index.php/abc/article/view/187

Article Details

Most read articles by the same author(s)

1 2 3 > >>